Depression and social anxiety related to emotional neglect in childhood
It is already well understood that maltreatment, sexual abuse or emotional neglect in childhood are risk factors for depression and anxiety disorders later in life. A new study shows which types of youth trauma are related to which types of psychological disorder.
Emotional neglect in childhood is a typical characteristic of people with depression, dysthymia (depression in a mild form, but lasting at least two years) and/or social anxiety disorders later in life. Sexual abuse - independently from emotional neglect or other traumatic experiences - has a specific link to dysthymia.
These are some of the striking findings of a study by psychologists and psychiatrists at Leiden University, the LUMC, the VU and the VUMC, into the relationship between negative childhood experiences and serious life events on the one hand and depression and anxiety later in life on the other hand. The researchers published on this subject in the Journal of Affective Disorders. Psychologist Philip Spinhoven described the results of the study together with other researchers from the department of Clinical Psychology and the department of Psychiatry at the LUMC.
The results further qualify existing hypotheses that relate anxiety disorders in particular to threatening experiences such as sexual abuse and maltreatment, and link depression primarily to emotional neglect, for example as a result of the lack oaf attention, support and empathy from parents or carers.
We already knew from previous research that negative youth experiences such as maltreatment, sexual abuse or emotional neglect are risk factors for the development and maintenance of depression and anxiety disorders. But the researchers intended with this new study to find out which type of youth trauma was related to which psychological disorder. With this information therapists can develop more purpose-built treatments and intervene at an earlier stage.
The researchers made use of data from NESDA, the Netherlands Study into Depression and Anxiety. This is a major long-term study of depression, anxiety and the combination of the the two. The study includes 2288 individuals who at some point in their lives have had one or more so-called affective disorders: anxiety disorders (general anxiety, social anxiety, panic disorder or agoraphobia without panic symptoms), depressive episodes or dysthymia. Of the survey group, 616 individuals had no symptoms at the time of the study. The study also included a control group consisting of 498 individuals with no history of anxiety or depression.
The participants were asked in interviews whether they had experienced emotional neglect and/or emotional, sexual or physical abuse before the age of sixteen. They were also asked about serious life events experienced during childhood, such as parental divorce or death, or institutionalisation. Using a standard questionnaire, the participants were also asked about major negative experiences during their lives, such as serious illness, death of a close friend unemployment, etc.
Previous studies were much more limited in scope and did not offer the benefits of statistical analysis and filtering provided by NESDA. They focused, for example, on the relation between abuse and depression and made pronouncements about it without taking into account that depression and anxiety often coincide, which distorts the picture. Negative youth experiences often also occur in combinations: sexual abuse and maltreatment frequently take place against the background of emotional neglect.
Individuals who had suffered from an anxiety disorder or depression reported more often in the NESDA study that they had experienced major life events than healthy individuals in the control group. Also, most youth traumas and to a lesser extent negative life events often coincided with almost all of the depressive and anxiety disorders. However, when corrected for concurrence of anxiety and depression and having experienced several stressful events, the picture became much more strongly differentiated.
The conclusions on the specific relation between emotional neglect and both dysthymia, depressive episodes and social anxiety are striking, the researchers write. Emotional neglect could explain not only part of the link between sexual and physical abuse and affective disorders, but may in themselves also be a significant factor in increasing the vulnerability to depression and anxiety.
This is useful knowledge, because emotional neglect occurs relatively frequently but is studied relatively rarely in comparison with other youth traumas. The new insights offer possibilities for more focused interventions.
The study was based on childhood memories of the participants, and therefore does not provide hard causal connections. If offers starting points for new research in the here and now. In the joint Leiden University research profile area of Health, prevention and the human life cycle of the Faculty of Medicine and Social and Behavioural Sciences, two reserach groups have been set up that will look at child abuse and social anxiety. Psychologist Spinhoven comments: ‘In a family lab study it would be possible to examine the influence of environmental factors such as child abuse on the development of social anxiety. In the Leiden Family Lab (LFL), several generations of a family will be studied in which a particular disorder occurs in order to investigate the influence of person and environment-related factors on the occurence of the disorder.'
In addition to the findings mentioned on emotional neglect and sexual abuse, the research also provided the following result:
The relation between depressive and anxiety disorders and negative youth experiences is greater than that with negative experiences later in life.
Childhood traumas are both characteristic for anxiety and for depressive disorders, athough there appears to be a greater relation to depressive disorders.
Individuals with more than one anxiety and depressive disorder more frequently reported a history of emotional neglect and sexual abuse. And: the more often the neglect and abuse took place, the stronger the connection.
The findings for those who had had an affective disorder are comparable with the findings for people who were suffering such a disorder at the time of the study. Ths suggests that the answers of this last group were not coloured by a negative mood when completing the questionnaire and during the interview.
The specificity of childhood adversities and negative life events across the life span to anxiety and depressive disorders
Philip Spinhoven, Ph.D.; Bernet Elzinga, Ph.D.; Jacqueline Hovens, M.D.; Karin Roelofs, Ph.D.; Frans Zitman, Ph.D.; Patricia van Oppen, Ph.D.; en Brenda Penninx, Ph.D.
Journal of Affective Disorders (2010) doi:10.1016/j.jad.2010.02.132
Het artikel is nog niet in druk verschenen maar is te raadplegen in PubMed als Epub publication ahead of print
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